Central Nervous System Infections in Patients Immunocompromised by Antineoplastic and Other Immune-Modulating Therapies

Abstract

Central nervous system (CNS) infections in patients receiving immunosuppressive therapy for cancer or other systemic conditions often present complex diagnostic challenges as signs of infection may be absent or atypical. This chapter outlines a systematic clinical approach based on the etiology of immunosuppression, general examination, and presence of concurrent systemic infections. Patients with impaired barrier function, neutropenia, B cell depletion, and T cell abnormalities are included. The laboratory and imaging diagnosis, management, and prognosis of infections such as PML, VZV, human herpesvirus 6, and fungal infections likely to be seen by practicing neurologists are discussed and contrasted with conditions that mimic infection. Infections associated with mycophenolate, cyclosporine, tacrolimus, rituximab, brentuximab, and alemtuzumab are described. Human immunodeficiency virus-associated infections are covered in Chap. 15.